4 Essential Tips for CHIP Benefits

The Children’s Health Insurance Program (CHIP insurance) attempts to fill a need in health care coverage for children.

Specifically, this type of insurance is available to families who have incomes that are too high to qualify them for Medicaid benefits.

This type of insurance represents a joint effort between the federal government and individual states to provide coverage to qualifying households.

Since state governments have input regarding how their programs are operated, CHIP coverage and eligibility can vary from state to state. 

CHIP was designed to ensure that no child goes without basic health care coverage.

Furthermore, remember that some states’ CHIP health insurance programs even provide coverage to pregnant women.

Applications can be submitted at any time and do not need to be filed within designated enrollment periods.

As a result, qualified individuals can begin receiving benefits quickly. This, in turn, can provide families with important health care assistance as soon as their applications are accepted. 

1. What does the Children’s Health Insurance Program cover?

All states provide CHIP insurance to qualifying children. However, what exactly a program covers can vary from one state to another.

You can check your state’s specific CHIP policies here. In any case, the following services are always covered by CHIP:

  • Doctor visits
  • Prescriptions
  • Immunizations
  • Routine checkups
  • Dental and vision
  • Lab and X-ray services
  • Emergency services

If you qualify for CHIP coverage, you will not need to purchase a secondary health care plan for your child.

Furthermore, you will never be asked to pay more than five percent of your family’s income for the year toward CHIP services. 

Furthermore, remember that your Children’s Health Insurance Program benefits may not be accepted everywhere.

As a result, you will need to take time to locate doctors and specialists in your area who accept CHIP.

Your Medicaid or CHIP agency websites typically supply a list of local providers who accept this form of payment. 

2. How do I find out if my child qualifies for CHIP? 

Fortunately, you can apply for CHIP and Medicaid using the same application process.

If you apply for Medicaid, you will automatically receive information about whether your children qualify for CHIP benefits. 

Most CHIP medicaid plans are either free or offered at very low cost to eligible families.

You can explore CHIP coverage options in more detail here. Regardless of where you live, the following factors are used to determine CHIP eligibility: 

  • Your household’s size
  • Your children’s residency/immigration status
  • Whether your children are covered by any other insurance plans
  • Whether your children are younger than 19 years of age

Though the income rules governing CHIP health insurance also vary by state, nearly every state offers coverage to families living at or up to 200 percent of the federal poverty level, which is $48,500 per year for a family of four.

However, some states allow families who earn more than this amount to enroll in CHIP coverage. Be sure to check with your state’s program office to learn if your household qualifies for benefits.  

Keep in mind that your child’s eligibility for CHIP insurance may shift and fluctuate as your life circumstances do.

If you obtain a job that increases your income above that which qualified your child for CHIP, you may no longer be eligible to be enrolled in this program.

The same may be true if a marriage or divorce takes place in your family. Therefore, it is important that you keep your CHIP office updated regarding any relevant changes that occur with your family. 

3. What steps and information go into the CHIP insurance application process?

When you decide to apply for CHIP health insurance, keep in mind there are different methods you can use.

If you submit a Medicaid application, your state agency will use this form to assess your CHIP eligibility.

However, if you do not want to take advantage of this option, you can apply for CHIP directly.

You can do this online through the Health Insurance Marketplace. Alternatively, you can call the program’s official number and apply by phone.  

If you believe your children may qualify for CHIP but you do not qualify for Medicaid, consider applying through the Health Insurance Marketplace site.

This way, you can learn about money-saving insurance options you may qualify for. Regardless of the method you use, be prepared to answer sensitive questions about your: 

  • Household’s income. 
  • Employment history. 
  • Children’s medical history. 

Once verified as a CHIP insurance recipient, you should be issued an enrollment card or receive an eligibility letter in the mail.

Contact your local CHIP agency if you need replacement copies of either of these documents.

You should be able to receive a new copy of your card at no additional cost to you. 

Likewise, be sure to contact your program office if you did not receive your insurance card even after you were were granted coverage through CHIP.

It is important that you have proof of coverage with you whenever you go to a doctor. This is because most providers will require you to present your CHIP insurance card in order to receive services.

To avoid difficulty at the doctor’s office, make sure you have this information with you before you seek medical attention. 

4. What do I do with my old Marketplace policy once I am on CHIP Medicaid? 

CHIP insurance and Medicaid both count as qualifying health coverage, or minimum essential coverage,  under the stipulations of the Affordable Care Act.

This means that once you have received an official determination of eligibility for CHIP, you can no longer participate in any Marketplace plan featuring savings on out-of-pocket costs or advance payments of the premium tax credit. 

It is your responsibility to immediately terminate any of these Marketplace coverage plans you may be currently enrolled in.

Otherwise, you could encounter difficulty in the future. If you would like to keep these Marketplace policies once your CHIP insurance has officially begun, you must pay full price for that Marketplace plan.